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With the supply scarce, Berkeley health officials are struggling to decide how to dole out potentially life-saving flu vaccines this winter—a challenge made more complicated by the fact that most of the doses are in private hands.

The nation-wide flu shortage is hitting the Bay Area and Berkeley especially hard, and it’s an impossible game of numbers to match the scant supply with the demand, said Berkeley Director of Public Health Poki Namkung Monday.

Although health officials say an estimated 26,000 Berkeley residents fall into the highest risk categories determined by the Centers for Disease Control and Prevention and should get a flu shot, the City of Berkeley only has control over 1,200 doses, 300 of which it had purchased from Aventis and the rest from the state’s portion given by the CDCP.

That’s about half the number of shots it has had in normal years.

The City of Berkeley will hand over its flu shots to doctors and community clinics to issue to their most high-risk patients. The department is still in the process of deciding who gets what.

An additional 4,000 vaccinations exist in the private sector, at hospitals, clinics, the University of California, and non-profit organizations.

“It’s a heartbreaking situation. It’s going to leave a huge number of people out,” Namkung said. “We are literally counting dose by dose, person by person.”

Namkung estimates that about 80 percent of the city’s health care providers appear to have ordered their supply of flu shots from Emeryville-based Chiron Corporation, which announced last month that none of its influenza vaccine would be available for the 2004-05 flu season.

Sutter VNA and Hospice, an affiliate of Sutter Health, is making 1,000 doses available at four Berkeley flu clinics. The non-profit group recently received 15,000 additional doses to be sold to high risk patients for $20 each in 11 California counties including Alameda, said spokeswoman Gerri Ginsburg.

The doses came from Aventis, although it was the Visiting Nurses Association of America, a national organization that works closely with the CDC, that advocated for the local group, Ginsburg said.

The group hasn’t advertised the new shipment aside from communicating with senior centers and posting the clinic schedule on its website.

“We’ve been keeping the word local and toward our target groups,” Ginsburg said.

Because of the shortage, California’s Public Health Officer Richard Jackson issued an order Oct. 8 with guidelines on who should receive the available vaccines.

Among them are adults over 65, children six to 23 months, and residents of nursing homes and long term care facilities. Namkung Oct. 13 reinforced the order with one of her own to include a declaration that must be signed by anyone receiving the vaccine stating they fall into one of the high-risk categories.

While all medical providers must follow the orders—to violate them is a misdemeanor—the state hasn’t issued additional guidelines to determine whether a pregnant woman, for example, should receive a flu shot before a person with asthma, said California Department of Health spokesman Robert Miller.

For its own 1,200 public-owned shots, the Berkeley City Health Department has itemized some of the criteria they use.

Its first priority, Namkung said, is to maintain the city’s health infrastructure. That means making sure emergency room doctors and critical care nurses—health care workers who come in close contact with patients and would be difficult to replace—have the opportunity to be vaccinated.

“We know, given the shortages, there will be many more flu cases than normal and there have to be health care providers to take care of sick patients,” Namkung said.

Next are the elderly who live in nursing homes, skilled nursing facilities and senior housing. The city’s vaccine supply won’t stretch beyond those two groups, Namkung said, although she does plan to hold onto about 100 doses to be used for small children, if necessary.

Those guidelines won’t extend into the private sector, where doctors will be left to determine which high-risk patient needs to be vaccinated the most.

Nurses at the VNA clinics will require flu shot recipients to sign the VNA’s own itemized sheet declaring that they are indeed high risk.

That could leave uninsured patients without access to the vaccine, Namkung acknowledged, especially since Berkeley canceled its senior flu vaccine clinics this year. About 3,000 of the 26,000 high-risk group are uninsured, she estimated.

While the health department will attend scheduled vaccination clinics, like the Sutter VNA clinic to be held at the Berkeley Jewish Community Center on Nov. 3, they won’t observe what goes on inside private medical centers to make sure they are following the CDC’s guidelines.

“I trust health care providers to do the right thing,” she said. “I haven’t seen any evidence that there is mishandling or misuse.”

Alta Bates Summit Medical Center has an additional 3,100 vaccinations, but will use them for their workers, Namkung said.

Elsewhere in the Bay Area, the San Francisco Department of Public Health has a policy similar to Berkeley’s—first vaccinating health care workers and people in nursing homes and long-term care facilities, according to Director Mitchell Catz.